Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)
| Autor: | Maxim J.H.L. Mulder, Saliha Ergezen, Hester F. Lingsma, Olvert A. Berkhemer, Puck S.S. Fransen, Debbie Beumer, Lucie A. van den Berg, Geert Lycklama à Nijeholt, Bart J. Emmer, H. Bart van der Worp, Paul J. Nederkoorn, Yvo B.W.E.M. Roos, Robert J. van Oostenbrugge, Wim H. van Zwam, Charles B.L.M. Majoie, Aad van der Lugt, Diederik W.J. Dippel, Wouter J. Schonewille, Jan Albert Vos, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A. van Oostayen, Jelis Boiten, Patrick A. Brouwer, Sebastiaan F. de Bruijn, Lukas C. van Dijk, L. Jaap Kappelle, Rob H. Lo, Ewoud J. van Dijk, Joost de Vries, Paul L.M. de Kort, Jan S.P. van den Berg, Willem Jan J. van Rooij, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Marieke C. Visser, Joseph C.J. Bot, Patrick C. Vroomen, Omid Eshghi, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Alexander V. Tielbeek, Heleen M. den Hertog, Dick G. Gerrits, Renske M. van den Berg-Vos, Giorgos B. Karas, Henk A. Marquering, Ludo F. Beenen, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Peter J. Koudstaal, H. Zwenneke Flach, Ewout W. Steyerberg |
|---|---|
| Přispěvatelé: | ACS - Amsterdam Cardiovascular Sciences, Radiology and Nuclear Medicine, ANS - Neurovascular Disorders, Graduate School, Neurology, Biomedical Engineering and Physics, Other Research, ARD - Amsterdam Reproduction and Development, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, ACS - Pulmonary hypertension & thrombosis, Radiology & Nuclear Medicine, Public Health, MUMC+: MA AIOS Neurologie (9), MUMC+: MA Neurologie (3), RS: CARIM - R3.03 - Cerebral small vessel disease, Klinische Neurowetenschappen, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: CARIM - R3.11 - Imaging, Beeldvorming |
| Rok vydání: | 2017 |
| Předmět: |
Male
endovascular treatment medicine.medical_treatment RECANALIZATION 030204 cardiovascular system & hematology GUIDELINES THERAPY Brain Ischemia EARLY MANAGEMENT law.invention 0302 clinical medicine Randomized controlled trial law Modified Rankin Scale Outcome Assessment Health Care EPIDEMIOLOGY Stroke Netherlands Endovascular Procedures blood pressure ASSOCIATION Thrombolysis Middle Aged Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] thrombectomy Cardiology Female Cardiology and Cardiovascular Medicine Intracranial Hemorrhages medicine.medical_specialty hypertension TISSUE-PLASMINOGEN-ACTIVATOR 03 medical and health sciences Internal medicine Post-hoc analysis ischemic stroke medicine Humans cardiovascular diseases Aged Retrospective Studies HEALTH-CARE PROFESSIONALS THROMBOLYSIS Advanced and Specialized Nursing business.industry Other Research Radboud Institute for Health Sciences [Radboudumc 0] Odds ratio medicine.disease Surgery Clinical trial Blood pressure Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Stroke; a journal of cerebral circulation, 48(7), 1869-1876. Lippincott Williams and Wilkins Stroke, 48(7), 1869-1876 Stroke, 48, 7, pp. 1869-1876 Stroke, 48(7), 1869-1876. Lippincott Williams & Wilkins Stroke, 48, 1869-1876 Stroke, 48(7), 1869-1876. LIPPINCOTT WILLIAMS & WILKINS |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.116.016225 |
| Popis: | Background and Purpose— High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. Methods— This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Results— Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09–1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. Conclusions— BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. Clinical Trial Registration— URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|